Safe birth in cultural safety

Working with Indigenous women in Mexico.


Safe birth in cultural safety: A cluster randomized control trial

Throughout the Americas, maternal and newborn mortality and morbidity among indigenous peoples is higher than in the overall population. Mainstream policies and programs encourage indigenous women to deliver in hospitals and clinics, with little regard for their traditions and cultural values. The Safe Birth in Cultural Safety initiative draws on both indigenous and biomedical knowledge and practices to improve maternal and newborn health without disrupting indigenous cultures. Between 2008 and 2012, a pilot study took place in Nancue Ñomndaa (Amuzgo) communities of Xochistlahuaca (Xochis), a rural indigenous community in Guerrero state, Mexico. The results suggested that women can safely give birth without having to give up their traditions in the process. The larger trial in Mexico (2015 to 2017) demonstrated that this culturally respectful way of doing things is not inferior to usual care in terms of mortality and serious childbirth complications and could bring additional benefits in the recovery of indigenous cultures.

2022 Sarmiento I, Paredes-Solís S, Legorreta-Soberanis J, Serrano-de los Santos RF, Zuluaga G, Cockcroft A, Andersson N. Safe motherhood in cultural safety in southern Mexico: a pragmatic non-inferiority cluster-randomised controlled trial. BMC Pregnancy and Childbirth 2022;22:43.
2022 Sarmiento I, Cockcroft A, Dion A, Paredes-Solís S, DeJesus-Garcia A, Melendez D, Chomat AM, Zuluaga G, Menesis-Rentería A, Andersson N. Combining conceptual frameworks on maternal health in indigenous communities — Fuzzy cognitive mapping using participant- and operator-independent weighting. Field Methods 2022;34:1-17.
2021 Sarmiento I, Paredes-Solís S, Dion A, Silver H, Vargas EM, Cruz MP, Pimentel J, Zuluaga G, Cockcroft A, Andersson N. Maternal health and Indigenous traditional midwives in southern Mexico: contextualisation of a scoping review. BMJ Open. 2021;11(12):e054542.
2020 Sarmiento, I., Paredes-Solís, S., Loutfi, D., Dion, A., Cockcroft, A., & Andersson, N. (2020). Fuzzy cognitive mapping and soft models of indigenous knowledge on maternal health in Guerrero, Mexico. BMC Medical Research Methodology, 20(1).
2020 Sarmiento, I., Zuluaga, G., Paredes-Solís, S., Chomat, A. M., Loutfi, D., Cockcroft, A., & Andersson, N. (2020). Bridging Western and Indigenous knowledge through intercultural dialogue: Lessons from participatory research in Mexico. BMJ Global Health, 5(9).



Centro de Investigación de Enfermedades Tropicales (CIET) de la Universidad Autónoma de Guerrero

Centro de Estudios Médicos Interculturales

Grupo de Estudios en Sistemas Tradicionales de Salud de la Universidad del Rosario

Country: Mexico

Dates: 2013 to 2017

Funding: The National Council of Science and Technology of Mexico (CONACyT, PDCPN-2013-214858) funded the cluster-RCT.
McGill University funded fieldwork for middle-term evaluation of the intervention (T244294C0G).
The Quebec Population Health Research Network (QPHRN) funded fieldwork and publications.
The Fonds de la recherche en santé du Québec, the Canadian Institutes of Health Research, CeiBA fundation and the Centro de Estudios Médicos Interculturales funded one doctoral student.